A groundbreaking surgical achievement has been made by the team at West Virginia University (WVU) Heart and Vascular Institute, led by Dr. Vinay Badhwar, the executive chair of the WVU Heart and Vascular Institute and the second vice president of the Society of Thoracic Surgeons. On October 31, 2024, the team performed the world’s first combined robotic aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) through a single small incision.
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Dr. Vinay Badhwar
The pioneering procedure was performed on 73-year-old Poppy McGee, a patient with a complex medical history, including a stroke, brain surgery, and significant weight loss. Referred to Dr. Badhwar for treatment of both aortic valve disease and coronary artery disease, McGee initially faced the prospect of traditional open-heart surgery. However, when she and her family learned of its risks—over a 10% chance of mortality and nearly 50% likelihood of complications—they inquired about alternative options.
Dr. Badhwar explained his team had developed a novel robotic approach that had yet to be tested on a patient. After a thorough discussion of the risks and benefits, McGee and her family agreed to proceed with the innovative robotic surgery.
The procedure involved both AVR and CABG, performed entirely robotically through a single incision on the far right of McGee’s chest. The success of the surgery has sparked optimism about the potential for broader adoption of robotic heart surgery for patients with complex conditions.
“While we are still in the early days of this latest innovation, the ability to perform valve surgery and coronary artery bypass surgery fully robotically through a single incision has the potential to open up a new era of robotic heart surgery,” Dr. Badhwar noted in a prepared statement. “We must always keep quality outcomes at the forefront of all innovation. However, if surgeons adopt and gain experience with techniques such as this one, they will tackle this last frontier that previously limited a robotic approach. One day in the near future, this may serve as a platform to perform nearly all types of heart surgery.”
This revolutionary procedure potentially paves the way for less invasive operations. Dr. Lawrence Wei, a professor at the WVU Department of Cardiovascular and Thoracic Surgery, remarked on the impact of this advancement: "Patients who have both valve disease and coronary artery disease have traditionally been treated by open-heart surgery performed through the breastbone. This new robotic technique could redefine how we approach these cases."
Dr. Goya Raikar, an assistant professor at WVU and a member of Badhwar’s robotics team, also underscored the procedure's significance: "Until now, the main exclusion for us to perform a robotic approach has been the coexistence of valve and coronary artery disease. Building on our experience with robotic aortic valve surgery, this new approach may help us extend robotic surgery options to many more patients."
The patient’s daughter, Mollie Wilcosky, expressed gratitude for the groundbreaking care provided by the WVU team. “We are so thankful for Dr. Badhwar and the team at the WVU Heart and Vascular Institute for developing this robotic procedure to help my mother recover so well,” Wilcosky said. “She is getting stronger every day.”
The full details of the procedure will be in The Annals of Thoracic Surgery, highlighting how innovative approaches like this continue to redefine the future of cardiothoracic surgery.
References:
• Cardiovascular Business article on the WVU Heart and Vascular Institute's groundbreaking surgery.
• WV News article detailing the multidisciplinary team and procedural innovations at WVU Medicine’s WVU Heart and Vascular Institute.
At the 2024 European Association for Cardio-Thoracic Surgery (EACTS) meeting in Lisbon, Portugal, leaders in cardiac surgery and interventional cardiology came together, signaling a newfound harmony over coronary revascularization practices for complex heart conditions. This session marked a significant change from the intense disagreements that followed the EXCEL trial controversy five years ago, which raised concerns about data interpretation in revascularization treatments for left main disease.
In a joint session between EACTS and the European Society of Cardiology (ESC), Dr. Alaide Chieffo (Vita Salute San Raffaele University, Milan) and Dr. Patrick Myers (Lausanne University Hospitals, Switzerland) presented a united front on revascularization strategy, referencing the ESC’s recent guidelines for managing chronic coronary syndromes (CCS) with a patient-centered approach. The guidelines, collaboratively crafted by cardiologists and surgeons, reflect a shared understanding of both PCI and CABG as valuable options for coronary artery disease based on individual patient conditions.
“We've gone full circle,” Dr. Myers told TCTMD. “The latest guidelines have a left main chapter that EACTS endorses because we all feel that this represents the evidence best. It's very positive to see that we've gone from surgeons unilaterally looking at the data and saying, ‘Wait a minute, this is not reasonable. We don't agree with this,’ to saying, ‘Okay, let's work on this together.’” His comments underscore the shift from discord to collaboration in developing best practices for patients with multivessel coronary artery disease, left main disease, and heart failure.
EACTS President Dr. Volkmar Falk (German Heart Center Berlin) echoed this sentiment, emphasizing that the endorsed guidelines demonstrate alignment with cardiologists and aim to serve patient needs effectively. He urged further collaboration by encouraging attendance at cardiology-focused conferences, saying, “Go to ESC, go to EuroPCR, be present at these meetings, and engage in the discussion there. It’s one thing to discuss this here at EACTS… We have to also join our cardiology friends and go to their meetings.”
In her presentation, Dr. Chieffo underscored that a “patient-centered” approach should guide heart team discussions for complex cases and highlighted that care recommendations depend on various factors—including hospital capabilities. She explained that CCS guidelines offer a Class I recommendation for CABG in low-surgical-risk patients and for PCI in low-anatomic-complexity cases, stressing that patient-centered care takes into account individualized patient needs rather than simply following patient preferences.
With the introduction of these guidelines, both EACTS and ESC reaffirm their commitment to improving outcomes through collaboration and shared expertise across disciplines, reflecting a renewed spirit of partnership in cardiovascular care.
It is time to reconsider the management of Aortic valve Disease (AVD) across the world. In South Asian and Sub-Saharan African nations, in low-income countries, AVD is treated with surgical aortic valve replacement (SAVR). Patients receive mechanical valves. The population is younger than in high-income countries and the disease is different, mostly of rheumatic origin.
CHICAGO, IL – October 17, 2024 – The Society of Thoracic Surgeons (STS) announces the release of two new risk calculators to inform physician-patient decision-making in thoracic surgery. Engineered using contemporary data from the STS General Thoracic Surgery Database, these interactive tools provide surgeons with accurate, preoperative risk estimations for outcomes of esophagectomy for cancer and pulmonary resection for lung cancer.
Earlier this month, more than 470 data managers attended the 2024 Advances in Quality & Outcomes: A Data Manager’s Meeting (AQO) in Nashville, both virtually and in person. Throughout the successful three-day event, surgical team data managers deepened their understanding of the STS National Database. They learned about new features, functionality, quality improvement initiatives, and research outcomes from surgeon leaders, Database platform experts, and fellow data managers. This expanded knowledge will help them be integral to their heart team as they lead their centers to improve clinical outcomes and patient safety using the STS National Database.
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Attendees included (l to r): Ram Kumar Subramanyan, MD, PhD; John E. Mayer Jr., MD; Timothe L’Heureux, MHA; Susana C. Reid, BSN, RN, CPN; Amanda McGlinchey, MHA, RN, CCRN; and Erin Hunter-McPhan, BSN, RN.
The event showcased the Database's unique analytical power in supporting ongoing outcomes analysis and continuous improvement efforts for each institution. Experts led in-depth discussions and presented four learning tracks to help users master each Database registry: Adult Cardiac, Congenital Heart, General Thoracic, and Intermacs/Pedimacs.
Here’s what a few attendees had to say:
“Thank you for the opportunity to speak at AQO this year. It was very well organized, and I felt I had excellent communication throughout the process. I know A LOT of work goes into coordinating events like this, so thank you for your efforts. It was really nice to get to talk with other users and share tips and tricks!” – Marie Wilson, MSHQS, MSN, RN, quality coordinator at University of Alabama at Birmingham Hospital
“The conference last week was great! I really enjoyed the presentations, Q&A, and meeting other data managers. Keep up the great work!”– Clera Sugarbaker, performance improvement analyst/abstractor at Vanderbilt University Medical Center
“Thank you for a great conference. I am proud to be a part of the STS Intermacs community. We truly do great things!! Looking forward to what is to come.” – Elizabeth Spreen, RN, clinical quality analyst at Baton Rouge General Medical Center
ProHealth Heart and Vascular Care in Waukesha, Wis., embarked on a multidisciplinary initiative to reduce ventilation times for isolated Coronary Artery Bypass Grafting patients at Waukesha Memorial Hospital. The goals: Reduce the risk of patient harm associated with mechanical ventilation and achieve significant improvements in teamwork and safety culture.
In the realm of cardiovascular care, ensuring adherence to quality metrics is paramount for achieving better patient outcomes. But having a lot of data is not enough. Every healthcare professional who plays a role on an integrated patient care team needs to be aware of the data available to them, understand what it means, and act on that understanding. And that’s a challenge that exists across the health system.
CHICAGO (April 26, 2024) ─ The expanding use of transcatheter technologies has changed the landscape in the treatment of valvular disease in adult cardiac patients, with valve surgery rapidly shifting to more complex interventions frequently involving other concomitant procedures.
